2. ENDOCRINOLOGY ADRENAL CORTEX DR SYED SHAHID HABIB MBBS FCPS DSDM

6. CORTEX ZONA GLOMERULO SA MINERALOCORTICOIDS (ALDOSTERONE) ZONA FASICULATA GLUCOCORTICOIDS (CORTISOL) PREDOMINANTLY ZONA RETICULARIS ANDROGENS (DEHYDROEPIANDROSTE RONE) PREDOMINANTLY MEDULLA CATECHOLAMINES (EPINEPHRINE AND NOREPINEPHRINE)

7. Class of Steroid Major Representative Physiologic Effects MineralocorticoidsAldosterone Na+, K+ and water homeostasis GlucocorticoidsCortisol Glucose homeostasis and many others Androgens Dehydroepiand rosterone Androgenic Activity

8. TWO TO THREE DOZEN

9. Source Primarily zona fasiculata Chemistry C21 Cortico Steroid Half Life 60-90 min Fate Conjugated in Liver and then Excreted in urine or bile. Transport Only about 10% free & 90 % bound to corticosteroid-binding globulin (transcortin) Cortisol

10. MECHANISM OF ACTION R Transformation of Receptor to expose DNA binding Domain Binding to Enhancer like Segment in DNA Pre mRNA mRNA Protein R EFFECTS

11. PHYSIOLOGIC EFFECTS OF GLUCOCORTICOIDS EFFECTS ON INTERMEDIARY METABOLISM CARBOHYDRATES FATS PROTEINS

12. PHYSIOLOGIC EFFECTS OF GLUCOCORTICOIDS EFFECTS ON METABOLISM Catabolic proteolytic action: Mobilization of amino acids from extrahepatic tissues: These serve as substrates for gluconeogenesis Gluconeogenesis, Glycogenesis and Anti Insulin Action Inhibition of glucose uptake in muscle and adipose tissue Lipolytic Action Stimulation of fat breakdown in adipose tissue: The fatty acids released by lipolysis are used for production of energy in tissues like muscle

13. EFFECTS ON INFLAMMATION AND IMMUNE FUNCTION Glucocorticoids have potent anti-inflammatory and immunosuppressive properties. PHYSIOLOGIC EFFECTS OF GLUCOCORTICOIDS OTHER EFFECTS OF GLUCOCORTICOIDS Glucocorticoids have multiple effects on FETAL DEVELOPMENT (maturation of the lung and production of the surfactant necessary for extrauterine lung function)

14. Physiologic Effect Clinical expression Cortisol DeficiencyCortisol exces CARBOHYDRATE METABOLISM Increased gluconeogenesis Decreased glucose utilization Hypoglycemiahyperglycemia Decreased sensitivity to insulin Increased Insulin sensitivity Insulin resistance PROTEIN METABOLISM Decreased extrahepatic amino acid utilization Increased gluconeogenesis HypoglycemiaDec protein in bone, skin, muscle Poor wound healing FAT METABOLISM Increased lipolysis, decreased lipogenisis Weight lossHyperlipemia Distribution of fatTruncal obesity

15. DIURNAL VARIATION

16. CORTISOL CRH ACTH Physical Stress Mental stress LIVER FATS MUSCLE BLOOD CELLS - - + + Phlebotomist FEEDBACK CONTROL OF CORTSOL SECRETION Trauma Pain Emotion

18. CUSHING’S SYNDROME

22. ALDOSTERONE Source Zona Glomerulosa Chemistry Steroid Half Life 20 min Fate Conjugated in Liver and then Excreted in urine or bile. Transport Only about 40% free & 60 % bound to Albumin

23. WHAT ARE THE TARGETS OF ALDOSTERONE?

24. ALDOSTERONE TARGETS Renal tubules Sweat Glands Salivary glands Gastrointestinal Tract Increases Na Epithelial channels

25. Effect Of Aldosterone On Cortical Collecting Duct

26. MECHANISM OF ACTION R Transformation of Receptor to expose DNA binding Domain Binding to Enhancer like Segment in DNA Pre mRNA mRNA Protein ENaCs Na K Adenosine Triphosphatase

27. Ushu